Assessing the relationship between psychosocial risk and pregnancy outcomes using the perinatal integrated psychosocial assessment (PIPA) tool.
anxiety
birth
depression
pregnancy
psychosocial stress
Journal
Birth (Berkeley, Calif.)
ISSN: 1523-536X
Titre abrégé: Birth
Pays: United States
ID NLM: 8302042
Informations de publication
Date de publication:
12 2022
12 2022
Historique:
revised:
17
01
2022
received:
11
08
2021
accepted:
17
02
2022
pubmed:
3
3
2022
medline:
11
11
2022
entrez:
2
3
2022
Statut:
ppublish
Résumé
The Perinatal Integrated Psychosocial Assessment (PIPA) tool screens for anxiety, depression, and psychosocial factors in pregnancy. We aimed to assess the association between PIPA-determined psychosocial risk and obstetric and neonatal outcomes. Cohort study of all pregnant women who gave birth at ≥20 weeks of gestation in 2017-2019 at a tertiary maternity hospital in, Sydney, Australia. Women completed PIPA at their first antenatal visit and were assigned a PIPA risk category. At-risk women were reviewed and referred for support. The association between PIPA risk category and obstetric and neonatal outcomes was evaluated using multivariable logistic regression adjusting for sociodemographic and pregnancy factors. In all, 5969 women completed PIPA; 71.4% were assessed no/low risk, 17.5% medium risk, and 11.1% medium-high/high risk. Compared with no/low-risk women, medium-high/high-risk women were more likely to remain in hospital for >72 hours (aOR 1.47 [95% CI 1.33-1.64]); to not be breastfeeding at discharge (aOR 1.77 [95% CI 1.20-2.61]); to have their infants experience birth complications (aOR 1.24 [95% CI 1.03-1.50]); and to be admitted to the NICU (aOR 1.63 [95% CI 1.26-2.11]). There was a modest increase in odds of cesarean birth (aOR 1.12 [95% CI 1.00-1.27]), and no association with preterm birth or low birthweight. The risk of adverse outcomes disappeared for medium-high/high-risk women referred for support. The PIPA tool identified one in 10 women at high psychosocial risk with increased risk of adverse obstetric and neonatal outcomes. Adverse outcomes were attenuated for high-risk women who were referred for extra support, suggesting that psychosocial review and referral for high-risk women may reduce the risk of adverse obstetric and neonatal outcomes.
Sections du résumé
BACKGROUND
The Perinatal Integrated Psychosocial Assessment (PIPA) tool screens for anxiety, depression, and psychosocial factors in pregnancy. We aimed to assess the association between PIPA-determined psychosocial risk and obstetric and neonatal outcomes.
METHODS
Cohort study of all pregnant women who gave birth at ≥20 weeks of gestation in 2017-2019 at a tertiary maternity hospital in, Sydney, Australia. Women completed PIPA at their first antenatal visit and were assigned a PIPA risk category. At-risk women were reviewed and referred for support. The association between PIPA risk category and obstetric and neonatal outcomes was evaluated using multivariable logistic regression adjusting for sociodemographic and pregnancy factors.
RESULTS
In all, 5969 women completed PIPA; 71.4% were assessed no/low risk, 17.5% medium risk, and 11.1% medium-high/high risk. Compared with no/low-risk women, medium-high/high-risk women were more likely to remain in hospital for >72 hours (aOR 1.47 [95% CI 1.33-1.64]); to not be breastfeeding at discharge (aOR 1.77 [95% CI 1.20-2.61]); to have their infants experience birth complications (aOR 1.24 [95% CI 1.03-1.50]); and to be admitted to the NICU (aOR 1.63 [95% CI 1.26-2.11]). There was a modest increase in odds of cesarean birth (aOR 1.12 [95% CI 1.00-1.27]), and no association with preterm birth or low birthweight. The risk of adverse outcomes disappeared for medium-high/high-risk women referred for support.
CONCLUSIONS
The PIPA tool identified one in 10 women at high psychosocial risk with increased risk of adverse obstetric and neonatal outcomes. Adverse outcomes were attenuated for high-risk women who were referred for extra support, suggesting that psychosocial review and referral for high-risk women may reduce the risk of adverse obstetric and neonatal outcomes.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
648-660Informations de copyright
© 2022 Wiley Periodicals LLC.
Références
Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005;106(5):1071-1083.
Grigoriadis S, Graves L, Peer M, et al. Maternal anxiety during pregnancy and the association with adverse perinatal outcomes: systematic review and meta-analysis. J Clin Psychiatry. 2018;79(5):17r12011.
Woods SM, Melville JL, Guo Y, Fan MY, Gavin A. Psychosocial stress during pregnancy. Am J Obstet Gynecol. 2010;202(1):61.e1-61.e7.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Mental Health Care in the Perinatal Period (C-Obs-48). Royal Australian and New Zealand College of Obstetricians and Gynaecologists; 2018.
Department of Health. Clinical Practice Guidelines: Pregnancy Care. Australian Government Department of Health; 2018.
Austin MP. Marcé International Society position statement on psychosocial assessment and depression screening in perinatal women. Best Pract Res Clin Obstet Gynaecol. 2014;28(1):179-187.
Austin MP, Highet N, The Expert Working Group. Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline. Centre of Perinatal Excellence; 2017.
Schmied V, Langdon R, Matthey S, Kemp L, Austin MP, Johnson M. Antenatal psychosocial risk status and Australian women's use of primary care and specialist mental health services in the year after birth: a prospective study. BMC Womens Health. 2016;16(1):69.
Reilly N, Black E, Chambers GM, et al. Study protocol for a comparative effectiveness trial of two models of perinatal integrated psychosocial assessment: the PIPA project. BMC Pregnancy Childbirth. 2017;17(1):236.
Schmied V, Reilly N, Black E, et al. Opening the door: midwives' perceptions of two models of psychosocial assessment in pregnancy- a mixed methods study. BMC Pregnancy Childbirth. 2020;20(1):451.
Centre for Epidemiology and Evidence. New South Wales Mothers and Babies 2018. NSW Ministry of Health; 2019.
Dobbins TA, Sullivan EA, Roberts CL, Simpson JM. Australian national birthweight percentiles by sex and gestational age, 1998-2007. Med J Aust. 2012;197(5):291-294.
Australian Bureau of Statistics. 2033.0.55.001 Socio-Economic Indexes for Australia (SEIFA), 2016. In: Commonwealth of Australia, ed. https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/2033.0.55.0012016?OpenDocument2018
Littleton HL, Bye K, Buck K, Amacker A. Psychosocial stress during pregnancy and perinatal outcomes: a meta-analytic review. J Psychosom Obstet Gynaecol. 2010;31(4):219-228.
Shapiro GD, Fraser WD, Frasch MG, Seguin JR. Psychosocial stress in pregnancy and preterm birth: associations and mechanisms. J Perinat Med. 2013;41(6):631-645.
Navaratne P, Foo XY, Kumar S. Impact of a high Edinburgh Postnatal Depression Scale score on obstetric and perinatal outcomes. Sci Rep. 2016;6:33544.
Eastwood J, Ogbo FA, Hendry A, Noble J, Page A, Early Years Research G. The impact of antenatal depression on perinatal outcomes in Australian women. PLoS One. 2017;12(1):e0169907.
Bayrampour H, Salmon C, Vinturache A, Tough S. Effect of depressive and anxiety symptoms during pregnancy on risk of obstetric interventions. J Obstet Gynaecol Res. 2015;41(7):1040-1048.
Walsh JL, Senn TE, Carey MP. Longitudinal associations between health behaviors and mental health in low-income adults. Transl Behav Med. 2013;3(1):104-113.
Stranges S, Samaraweera PC, Taggart F, Kandala NB, Stewart-Brown S. Major health-related behaviours and mental well-being in the general population: the Health Survey for England. BMJ Open. 2014;4(9):e005878.
Reynolds CME, Egan B, Daly N, McKeating A, Sheehan SR, Turner MJ. The interaction between maternal smoking, illicit drug use and alcohol consumption associated with neonatal outcomes. J Public Health. 2020;42(2):277-284.
Parfitt Y, Ayers S. Transition to parenthood and mental health in first-time parents. Infant Ment Health J. 2014;35(3):263-273.
Grigoriadis S, VonderPorten EH, Mamisashvili L, et al. The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry. 2013;74(4):e321-e341.
Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67(10):1012-1024.
Stein A, Pearson RM, Goodman SH, et al. Effects of perinatal mental disorders on the fetus and child. Lancet. 2014;384(9956):1800-1819.
Accortt EE, Cheadle AC, Dunkel SC. Prenatal depression and adverse birth outcomes: an updated systematic review. Matern Child Health J. 2015;19(6):1306-1337.
Jarde A, Morais M, Kingston D, et al. Neonatal outcomes in women with untreated antenatal depression compared with women without depression: a systematic review and meta-analysis. JAMA Psychiatry. 2016;73(8):826-837.
Australian Institute of Health and Welfare. Maternal Deaths in Australia 2015-2017. AIHW; 2020. Cat. no. PER 106.
Knight M, Bunch K, Tuffnell D, et al. Saving Lives, Improving Mothers' Care - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2016-18. National Perinatal Epidemiology Unit, University of Oxford; 2020.
van Ravesteyn LM, Lambregtse-van den Berg MP, Hoogendijk WJ, Kamperman AM. Interventions to treat mental disorders during pregnancy: a systematic review and multiple treatment meta-analysis. PLoS One. 2017;12(3):e0173397.
Miller ES, Saade GR, Simhan HN, et al. Trajectories of antenatal depression and adverse pregnancy outcomes. Am J Obstet Gynecol. 2021;226(1):108.e1-108.e9.